1215281191 NPI number — MRS. ALEXIS MAE DE BRAGANCA LCSW

Table of content: MRS. ALEXIS MAE DE BRAGANCA LCSW (NPI 1215281191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215281191 NPI number — MRS. ALEXIS MAE DE BRAGANCA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE BRAGANCA
Provider First Name:
ALEXIS
Provider Middle Name:
MAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRATKA
Provider Other First Name:
ALEXIS
Provider Other Middle Name:
MAE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215281191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 EAST 16TH STREET
Provider Second Line Business Mailing Address:
INSTITUTE FOR FAMILY HEALTH MANHATTAN OFFICE
Provider Business Mailing Address City Name:
NY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-633-0800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 E 16TH STREET
Provider Second Line Business Practice Location Address:
INSTITUTE FOR FAMILY HEALTH MANHATTAN OFFICE
Provider Business Practice Location Address City Name:
NY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-633-0800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  078488 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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